Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was a 6 month old male who presented with respiratory distress and a fever.
Clinical Physical Exam:
Febrile, mild respiratory distress.
Clinical Differential Diagnosis:
Chest films on the day of admission showed a large round opacity in the left lower lobe that abutted the diaphragm. An ultrasound from the second hospital day demonstrated a large heterogeneous mass that appeared to be subdiaphragmatic and separate from the kidney and spleen. An MRI exam from the 5th hospital day demonstrated a posterior mediastinal mass that extended into the retrocrural regions of the chest bilaterally. A bone scan from the 5th hospital day (not provided) showed no evidence of metastatic disease. Chest CT exam performed 2 weeks after initial presentation revealed a vascular mass that was not calcified in the lower left chest with retrocrural adenopathy.
Images 1 and 2
Images 4, 5, 6
Imaging Differential Diagnosis:
The patient was taken to the operating room 13 days after the initial presentation for a diagnostic biopsy of the mass. A left thoracotomy incision was made. A large mass was found, occupying the entire lower chest. It was inflamed and had vessels coming into it from the lung. Part of the mass crept down into the crura. A large vessel was identified going from the aorta into the mass. A frozen section from the mass identified it to be an infected extralobar sequestration.
The mass was 8 x 7 x 6 cm in size. Pathological examination revealed it to be an extralobar pulmonary sequestration with cystic adenomatoid transformation. Mucus stasis with acute and chronic inflammation was also noted.
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
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